‘Ask Emily’: Legions stuck waiting for Medi-Cal

“One-stop shop,” “no wrong door” — state officials have used those phrases since last year to describe the new, easier, more efficient Medi-Cal application process.

But something happened between their mouths and reality: “A hole fell out of the middle of the system,” said Jen Flory, senior attorney for the Western Center on Law & Poverty.

Now, nearly 1 million Californians are stuck in a monumental backlog of Medi-Cal applications that shows few signs of abating. Some had applied as soon as enrollment began in October last year.

I hear from them every day: people who have heard nothing for months, people who are sick, need care and don’t know what to do.

In today’s column, I will describe what went wrong with the Medi-Cal expansion and what you can do if you’re still waiting ...

I applied for health coverage through Covered California. I filled in the application online and was told I was eligible for Medi-Cal ... After a few weeks with no communication, I called my local office and was told to call back in four weeks. I called back, and the lady told me I have been approved but I should call back in May. I called back in May, and a gentleman said my application is still pending. This entire process began on February 3, and we are now in June. Do you have any advice?

Yes, but first a quick refresher: Medi-Cal is the state’s version of the federal Medicaid program, designed to provide publicly funded insurance to low-income Californians.

The expansion is expected to push enrollment in Medi-Cal to 30 percent of the state’s population.

Since Oct. 1, when enrollment began, state officials urged Californians who might be eligible for the Medi-Cal expansion to apply via the website for Covered California, the state’s health insurance exchange.

Those who enrolled from October through December were told they could look forward to coverage starting in January. The central website was supposed to be able to determine income eligibility and communicate that to county social service agencies, which do the final processing using different computer systems.

Thus the “one-stop shop” and “no wrong-door” talk. But instead of those terms, Flory describes what actually happened as “jaw-dropping,” an “overwhelming mess” and a “fiasco.”

It turns out the Covered California website, which cost $454 million and counting, couldn’t communicate with the county systems for months and had programming defects that caused applications to be wrongly denied and put on hold, said Frank Mecca, executive director of the County Welfare Directors Association of California.

Advertisement

“The plan was that the interface (among the computer systems) would be ready on Oct. 1,” he said. “It wasn’t ready until Jan. 21.” The outcome? “Most of those applications could not be processed and were essentially stuck there.”

Then the state got slammed with more applications than expected. As of March 31, 1.9 million had enrolled in Medi-Cal, compared with the 1.4 million Californians who purchased Covered California plans.

In addition, some people didn’t provide documents that would allow the state to verify eligibility, said Tony Cava of the state Department of Health Care Services (DHCS), which administers Medi-Cal.

As a result, a whopping 900,000 Medi-Cal applicants remain in enrollment purgatory, and more than half of those applied within the last 45 days. By law, applications are supposed to be processed within that time frame, Cava said.

Still, there are some steps you can take if your application is stalled or if you need care while waiting:

Call or visit your county human services office to kick-start your application. You can find contact information on the DHCS website. If you need medical care, Cava said, the county may be able to give you a temporary identification card that permits you to access services until your enrollment is complete.

If you can’t get through to a county worker and you’ve been waiting more than 45 days, call the state at 855-795-0634 to request a hearing, Flory noted.

Please note that eligibility dates back to the month you applied, so you may be able to get paid back for your non-emergency costs assuming you received care from a doctor or hospital that accepts Medi-Cal, Flory said, adding that emergency care is covered wherever you receive it.

You may receive retroactive benefits for the 90 days prior to your application date, but for anyone just considered eligible under the new Medi-Cal rules, your retroactive coverage cannot pre-date January 1, Cava said.

Medi-Cal enrollment continues all year. Given the troubles I’ve just described, you may think it’s not worth applying, even if you believe you’re eligible.